Dog ACL (CCL) surgery cost: what TPLO and other cruciate repairs cost

A tibial plateau leveling osteotomy (TPLO), one of the main operations for a torn cruciate ligament, averaged $3,525 in the US, with a range of $2,793 to $6,417 by location. That comes from a 2025 study ASQ360 Market Research ran for CareCredit, a Synchrony Bank credit card that finances vet bills. The eight clinics we checked on October 5, 2026 publish one-knee TPLO prices from $3,500 to $6,000.

Quick answer

National average for a TPLO: about $3,500. At the eight clinics in our table: $3,500 to $6,000 for one knee, and $6,000 to $9,000 for both knees priced together. Lateral suture repair, which doesn’t cut bone, is listed at $2,250 and $4,200.

Procedure, size, location and what’s bundled in move the number. The other knee may tear later (19% of older dogs in one study below, 48% of Labradors in another), and insurance treats a knee problem noticed before coverage or during a waiting period as pre-existing. The treatment decision is yours and your vet’s.

ACL, CCL, cruciate: the ligament and the injury

The cranial cruciate ligament (CCL, also abbreviated CrCL) is one of the main stabilizers inside the knee, which vets call the stifle. In people the same ligament is the anterior cruciate ligament, so owners and many clinics say “ACL” for dogs too.

The American College of Veterinary Surgeons (ACVS) calls this cranial cruciate ligament disease: rupture is “a result of subtle, slow degeneration that has been taking place over a period of time rather than the result of a sudden trauma to an otherwise healthy ligament (which is very rare).”

Tears can be partial or complete, and a partial tear “almost always progresses to a full tear over time.” The meniscus, a cushion inside the joint, “can be damaged when the CrCL is ruptured.”

The surgeries, and who does them

In people the ligament is often replaced, but the ACVS says that “has not been possible with dogs.”

• Cutting and repositioning bone. A tibial plateau leveling osteotomy (TPLO) makes a curved cut across the top of the shinbone and rotates that piece to level the joint surface. A tibial tuberosity advancement (TTA) cuts along the front of the shinbone and moves that piece forward. A center of rotation of angulation (CORA)-based leveling osteotomy (CBLO) is a TPLO-like cut in a different place. TPLO and TTA use a plate and screws while the bone heals.
• No bone cut. An extracapsular repair, also called a lateral suture, lateral fabellar suture or lateral fabellotibial suture, places heavy suture outside the joint while scar tissue forms. TightRope anchors a special suture through holes drilled in the thighbone and shinbone.

The ACVS says many surgeons prefer the bone-cutting procedures for large, active dogs, and some for small dogs and cats too, and that the extracapsular repair, “often less costly,” “may not be the best choice for larger and younger patients.”

The evidence behind those preferences isn’t uniform, and much of it is low-level. A systematic review of 34 studies, 20 of them the lowest grade of evidence, found the evidence “most strongly supports” TPLO for returning dogs to normal function, with strong support for better recovery than lateral suture in the intermediate period after surgery, and too little data to judge other procedures (Bergh et al. 2014, PMID 25028440).

One prospective, non-randomized study of 65 medium to large dogs found no significant difference between TPLO and lateral suture in force-plate measurements or X-ray arthritis scores out to 24 months (Au et al. 2010, PMID 20210964). Arthritis progresses regardless of treatment, per the Merck Veterinary Manual.

Who operates. “All primary care veterinarians may perform surgery as part of their veterinary practice,” the ACVS says. Board-certified surgeons (DACVS) have completed at least a one-year internship, a three-year residency and the college’s board examinations.

TPLO “requires specialized equipment and is usually performed in veterinary teaching hospitals or a referral center,” the University of Florida’s hospital notes. In our table, some clinics name board-certified surgeons and others don’t state a surgeon’s credential.

What it costs: the national figures

The one national figure we found comes from a lender’s study: ASQ360 Market Research ran it in all 50 states and Washington, DC, in 2025 for CareCredit. The page cites the study’s cost tables but doesn’t link them or describe its methods; its footnote says some fees “may be charged in addition to the procedure costs.”

State averages run from $2,830 in Mississippi to $6,332 in Hawaii; in our table’s states, California $4,701, Colorado $3,576, Kansas $2,926, North Carolina $3,277, South Carolina $3,236 and Virginia $3,403.

A 2021 University of Missouri handout put its complete TPLO charge for small to large dogs at $4,000 to $4,500, and $4,500 to $5,000 for giant breeds “to accommodate a larger bone plate and additional screws,” excluding the eight-week recheck. Prices have risen since: the federal price index for veterinarian services rose 44.4% from August 2021 to August 2026.

Prices eight clinics publish

These are clinics that post a cruciate surgery price on their own websites, read on October 5, 2026. This isn’t a survey, we have no relationship with any of them, and a listing here is not a recommendation.

Clinic and who operates	Published price	Included, per the page
Mission Veterinary Emergency & Specialty, Mission, Kansas: specialty hospital, team “led by one of our board-certified veterinary surgeons”	TPLO $3,500; both knees, same surgery, $6,000; consult $200	Bloodwork, X-rays before and after, implants, hospital stay, pain control; not priced by size
Affordable Veterinary Surgery, six North Carolina animal hospitals and clinics; its doctors page describes “advanced training” in surgery	Lateral suture $2,250; TightRope $2,500; TPLO $3,700; $250 more over 100 lb	Exam, anesthesia and monitoring, X-rays including at recheck, recheck visits
CVETS, Columbia, South Carolina: 24/7 hospital listing two board-certified surgeons and surgery residents	TPLO $4,000	“everything from the initial examination to surgery and follow-up visits”; extra for added anesthesia screening or “nonstandard implants”
True Companions Animal Shelter & Clinic, Denver, Colorado: nonprofit; surgeon not named on the price page	TPLO $4,000 to $4,200, animals up to 80 lb	Not stated
Oakdale Veterinary Group, Oakdale, California: surgeon not named on the price page	TPLO $4,450 up to 70 lb; over 100 lb $4,450 to $5,950 by plate; 70 to 100 lb priced after surgery	Rechecks, X-rays, overnight stay
Anicira Veterinary Center, Manassas, Virginia and Encinitas, California: nonprofit, “experienced surgical team”	Manassas: TPLO $4,850 to $5,750. Encinitas: TPLO $5,200, both knees $7,500, $300 more over 100 lb	Exam, anesthesia monitoring, pain medication; outpatient; free follow-ups; bloodwork not listed
Warm Springs Pet Hospital (price list), Fremont, California: says it has “performed over 3,500 TPLOs”; surgeon’s credential not given on the price page	TPLO $5,200; CBLO $5,700; lateral suture $4,200	For TPLO: day-of X-rays, IV catheter, blood work, medicines, cone; follow-ups not included
TruVet Specialty & Emergency Hospital, Petaluma, California: a named staff surgeon	TPLO $6,000; both knees, one after the other, $9,000; consult $250	Rechecks billed separately

Checked October 5, 2026. These are dated examples of published prices; confirm with the clinic.

About these eight only: every one-knee TPLO price except Oakdale’s lowest tier sat above the study’s average for the clinic’s state. That may not generalize, because clinics that post prices are a self-selected group and an all-in package may cover items the study’s figure doesn’t.

What the bill includes, and why two estimates differ

• The procedure. Colorado State University’s hospital lists “the lower cost and the lack of a bone cut” among the extracapsular repair’s advantages. Where a clinic in our table priced both, its lateral suture was $1,000 to $1,450 less than its TPLO.
• Size. Bigger dogs can need a bigger plate. Missouri’s 2021 handout lists $500 more for giant breeds, two clinics add $250 or $300 over 100 lb, one prices by plate size, and one doesn’t price by size.
• X-rays. TPLO and TTA need specific views, and “your surgeon may need to repeat radiographs of the knee even if your veterinarian has already taken some,” Colorado State says.
• Stay and rechecks. Some packages include the stay and rechecks; Missouri’s eight-week recheck “will be charged separately.”
• The meniscus. The surgeon examines it and removes any damaged part. In one surgeon’s 1,000 TPLO dogs, it was already torn in 33.2% and tore later in 2.8% (Fitzpatrick and Solano 2010, PMID 20345526; retrospective); a systematic review found the evidence too weak to set the true frequency (McCready and Ness 2016, PMID 27168486). The Merck Veterinary Manual puts a later meniscal injury at “approximately 2-30% of cases, depending on the stabilization techniques used.” In a TTA series, a later meniscal tear counted as a major complication, one needing more surgery (Lafaver et al. 2007, PMID 17686132). No price page says whether meniscal treatment is included.
• Complications. Counts vary by study, and these studies used different patient groups and methods, so the percentages should not be used to rank the procedures. A review of TPLO reports gives 10 to 34%, with about 2 to 4% needing revision surgery (Bergh and Peirone 2012, PMID 22534675). Lateral suture: 17.4% of 363 procedures in one series, and 26 dogs (7.2%) needed a second surgery (Casale and McCarthy 2009, PMID 19210241). TTA: 31.5% of 101 dogs, 12.3% major (Lafaver et al. 2007). Both series are retrospective. No price page says it covers a second operation.

The other knee

Because the disease is usually degenerative, Colorado State’s hospital explains, the other knee is at risk too. Rates depend on who was studied:

• 48% of 94 Labradors treated with TPLO tore the other ligament, a median of 5.5 months later (Buote et al. 2009, PMID 19538670; one breed, case series).
• 19.1% of 831 dogs aged 8 or older and at least 15 kg did, a median of 12.9 months later, and the risk “decreases as they age” (Murphy et al. 2024, PMID 37487534; retrospective).
• In 84 dogs whose other knee felt normal, an X-ray finding called the infrapatellar fat pad sign meant an 85.3% three-year probability of rupture, against 24.9% without it (Fuller et al. 2014, PMID 24432965; retrospective).

Some clinics price both knees together ($6,000 to $9,000 in our table). Same-day surgery on both knees is a surgical call; two series disagree: one found more complications with same-session bilateral TPLO (Priddy et al. 2003, PMID 12830866; 193 dogs), the 1,000-dog series found no difference (Fitzpatrick and Solano 2010).

Surgery or not

The sources lean toward surgery. The Merck Veterinary Manual says non-surgical care “could be considered for animals with very mild clinical signs, for cases of early injury, or for small dogs and cats; however, most patients would benefit from surgical management.”

Colorado State’s hospital says rest and pain medication don’t stabilize the knee and are “generally not advised, but it may be appropriate for individual dogs due to some combination of their very small size, inactive lifestyle, other concurrent injuries or diseases, or financial realities.”

What studies measured:

• A randomized trial of 40 overweight dogs, all given physical therapy, weight loss and anti-inflammatory medication: probability of success at one year, 75.0% with TPLO and 63.6% without; at 24 weeks, 92.6% against 33.3% (Wucherer et al. 2013, PMID 23634680; a small trial, overweight dogs only).
• UK veterinary records (VetCompass) of 815 dogs: lameness was 25.7 percentage points less common short term, and 31.7 points long term, after surgery (Pegram et al. 2024, PMID 38503655; observational, statistically adjusted).
• Custom braces: in an owner survey, a larger share of TPLO owners reported mild or no lameness and rated the treatment good or better; of 151 brace owners answering, 46% reported skin sores and 11% a later surgery (Hart et al. 2016, PMID 27479283; owner-reported, low response).

If the estimate is out of reach, tell your vet. “Financial realities” are on that hospital’s list.

Recovery, and what it adds to the bill

Missouri’s TPLO instructions call for cage rest with “absolutely no running, jumping, playing or stairs for the first eight weeks” and recheck X-rays at eight weeks. Florida’s hospital asks for at least three months of exercise restriction after any cruciate repair, with most dogs allowed back to normal activity after three to four months.

Packages differ on rechecks, X-rays, take-home medication and rehabilitation; none of the eight price pages lists a rehabilitation course in its price.

Questions to ask when you get an estimate

• Which procedure, and why? Are there alternatives?
• How often have you performed this surgery, and would a board-certified surgeon be better for my dog? (Both are ACVS questions.)
• Were both knees X-rayed, and can my vet’s X-rays be used?
• What’s included: bloodwork, implant, stay, medication, cone, meniscal treatment, rechecks and X-rays? Is rehabilitation extra?
• Is there a size surcharge, and what happens to the bill after a complication?
• Which payment options do you take?

Paying for it

What insurance does and doesn’t do

A policy pays toward covered conditions and can exclude pre-existing ones; under the NAIC’s model law, even “signs or symptoms directly related to the condition” before coverage or during a waiting period can make a condition pre-existing. Three points matter for knees (documents read October 5, 2026):

• A knee problem noticed before coverage or during a waiting period counts as pre-existing. Spot’s sample California policy (form PET-P-20000-CA-IAIC-1024) excludes “Ligament and knee conditions, if any ligament and knee condition occurred prior to the first effective date of the applicable coverage or during a waiting period.”
• Some policies set a waiting period for orthopedic or cruciate problems. The same Spot sample has “a 14 day waiting period for diagnosis, treatment or surgery related to any illness,” orthopedic illness included. An older example, not current California terms: a Pets Best sample policy dated February 2023 (form IAIC-PBI0001-ILL (02/2023), California disclosure page) lists “6 months following the Policy Effective Date for any Cruciate Ligament Events and any related Conditions.” That sample predates a California law, in effect since January 1, 2025, that limits waiting periods to those “that do not exceed 30 days for illnesses or orthopedic conditions not resulting from an accident” (Insurance Code section 12880.7). Waiting periods differ by insurer, state and policy date, so ask any insurer for its current policy for your state and read the declarations page.
• Some policies treat both knees as one. Healthy Paws’ general coverage page says “if the cruciate ligament on one leg is injured prior to enrollment or during the 15-day waiting period, then the cruciate ligament on the other leg is excluded from coverage.”

Terms differ by state and plan, and nothing here ranks an insurer. For older or already-diagnosed dogs, see our insurance guide for older dogs.

Other ways owners pay

• Savings, or a payment arrangement with the clinic.
• Medical credit cards and vet financing; clinics in our table name CareCredit, Scratchpay and Cherry. These are credit (“Subject to credit approval,” CareCredit’s page notes).
• Nonprofit clinics and charitable funds; two organizations in our table are nonprofits. The ACVS says financial aid exists “in select cases, but it is very hard to come by.”

More on each option: help with vet bills.

Keep reading

Surgery Recovery at Home

Incision checks, cones and call-now signs.

Help With Vet Bills

Payment plans, credit, charities and the clinic conversation.

Weak Back Legs

What usually causes it in older dogs.

References and further reading

• American College of Veterinary Surgeons. Cranial Cruciate Ligament Disease (owner page, updated July 22, 2026). acvs.org
• American College of Veterinary Surgeons. What is a veterinary surgeon? acvs.org
• American College of Veterinary Surgeons. Questions for your veterinarian (includes “Is financial aid available for surgical procedures?”). acvs.org
• Lafuente P. Joint Trauma in Dogs and Cats (professional version, full review December 2025). Merck Veterinary Manual. merckvetmanual.com
• Duerr F. Canine cruciate ligament injury. Colorado State University Veterinary Health System. csuveterinaryhealth.org
• University of Florida Small Animal Hospital. Cranial Cruciate Ligament Rupture. vethospital.ufl.edu
• University of Missouri Veterinary Health Center. Cranial Cruciate Ligament Disease and the Tibial Plateau Leveling Osteotomy (TPLO), client handout, 2021. vhc.missouri.edu (PDF)
• Au KK, Gordon-Evans WJ, Dunning D, et al. Comparison of short- and long-term function and radiographic osteoarthrosis in dogs after postoperative physical rehabilitation and tibial plateau leveling osteotomy or lateral fabellar suture stabilization. Vet Surg. 2010;39(2):173-180. PMID 20210964
• Bergh MS, Peirone B. Complications of tibial plateau levelling osteotomy in dogs. Vet Comp Orthop Traumatol. 2012;25(5):349-358. PMID 22534675
• Bergh MS, Sullivan C, Ferrell CL, Troy J, Budsberg SC. Systematic review of surgical treatments for cranial cruciate ligament disease in dogs. J Am Anim Hosp Assoc. 2014;50(5):315-321. PMID 25028440
• Buote N, Fusco J, Radasch R. Age, tibial plateau angle, sex, and weight as risk factors for contralateral rupture of the cranial cruciate ligament in Labradors. Vet Surg. 2009;38(4):481-489. PMID 19538670
• Casale SA, McCarthy RJ. Complications associated with lateral fabellotibial suture surgery for cranial cruciate ligament injury in dogs: 363 cases (1997-2005). J Am Vet Med Assoc. 2009;234(2):229-235. PMID 19210241
• Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg. 2010;39(4):460-474. PMID 20345526
• Fuller MC, Hayashi K, Bruecker KA, et al. Evaluation of the radiographic infrapatellar fat pad sign of the contralateral stifle joint as a risk factor for subsequent contralateral cranial cruciate ligament rupture in dogs with unilateral rupture: 96 cases (2006-2007). J Am Vet Med Assoc. 2014;244(3):328-338. PMID 24432965
• Hart JL, May KD, Kieves NR, et al. Comparison of owner satisfaction between stifle joint orthoses and tibial plateau leveling osteotomy for the management of cranial cruciate ligament disease in dogs. J Am Vet Med Assoc. 2016;249(4):391-398. PMID 27479283
• Lafaver S, Miller NA, Stubbs WP, Taylor RA, Boudrieau RJ. Tibial tuberosity advancement for stabilization of the canine cranial cruciate ligament-deficient stifle joint: surgical technique, early results, and complications in 101 dogs. Vet Surg. 2007;36(6):573-586. PMID 17686132
• McCready DJ, Ness MG. Systematic review of the prevalence, risk factors, diagnosis and management of meniscal injury in dogs: Part 1. J Small Anim Pract. 2016;57(2):59-66. PMID 27168486
• Murphy CL, Niles J, Radasch RM. The prevalence and risk factors of contralateral cranial cruciate ligament rupture in medium-to-large (>=15kg) breed dogs 8 years of age or older. Vet Comp Orthop Traumatol. 2024;37(1):8-12. PMID 37487534
• Pegram C, Diaz-Ordaz K, Brodbelt DC, et al. Target trial emulation: does surgical versus non-surgical management of cranial cruciate ligament rupture in dogs cause different outcomes? Prev Vet Med. 2024;226:106165. PMID 38503655
• Priddy NH 2nd, Tomlinson JL, Dodam JR, Hornbostel JE. Complications with and owner assessment of the outcome of tibial plateau leveling osteotomy for treatment of cranial cruciate ligament rupture in dogs: 193 cases (1997-2001). J Am Vet Med Assoc. 2003;222(12):1726-1732. PMID 12830866
• Wucherer KL, Conzemius MG, Evans R, Wilke VL. Short-term and long-term outcomes for overweight dogs with cranial cruciate ligament rupture treated surgically or nonsurgically. J Am Vet Med Assoc. 2013;242(10):1364-1372. PMID 23634680
• CareCredit (Synchrony). How Much Does CCL (ACL) Surgery for Dogs Cost? (dated April 24, 2026), citing the 2025 Synchrony Average Procedural Cost Study conducted by ASQ360 Market Research. A lender’s page, cited for its figures only. carecredit.com
• US Bureau of Labor Statistics. Consumer Price Index for All Urban Consumers: Veterinarian services, US city average, not seasonally adjusted (series CUUR0000SS62054). data.bls.gov
• Spot Pet Insurance (Independence American Insurance Company). Sample accident and illness policy, California, form PET-P-20000-CA-IAIC-1024. sample policy (PDF)
• Pets Best (Independence American Insurance Company). Sample accident and illness policy, form IAIC-PBI0001-ILL (02/2023), with California Insurer Disclosure of Important Policy Provisions. sample policy (PDF)
• Healthy Paws Pet Insurance. Pet insurance coverage and exclusions. healthypawspetinsurance.com
• California Insurance Code section 12880.7 (added by Stats. 2024, Ch. 612, SB 1217; effective January 1, 2025). leginfo.legislature.ca.gov
• National Association of Insurance Commissioners. Pet Insurance Model Act (#633), section 3F, definition of preexisting condition. naic.org (PDF)
• Clinic price pages: linked in the table above, all read October 5, 2026.

Frequently asked questions

This guide is general information about paying for veterinary care, not veterinary, insurance, legal or financial advice. Prices, terms and eligibility rules change; check them with the provider. Treatment decisions belong with your veterinary team.